Managing To Care

Nurses, the patient's lifeline to recovery in the hospital, say they often find themselves stretched so thin during their 12-hour shifts that they simply cannot do everything their patients need.

And the modern patient population needs a lot of care.

In the era of managed care, usually only the sickest and those requiring surgery in a hospital operating room are admitted, said Belinda Heisler, a critical care nurse who serves on the board of the Tampa-based Association for Responsible Medicine, a consumer protection group.

"In the past five years, the patients-to-nurse ratios have dramatically increased," Heisler said. "Patients are older and sicker.

"The routine medical-surgical floor patient of today was yesteryear's intensive care patient," she said. "The intensive care patient of today is surrounded by advanced drug and machine technology not available five to 10 years ago."

A survey of 80 Florida hospitals in 1999 by the Florida Hospital Association found they were having difficulty finding qualified nurses to hire. A majority of the hospitals said they had a shortage and one-quarter considered it severe.

Of more than 1,600 registered nurse positions open in Florida, vacancy rates were highest in the positions requiring experienced nurses with extra training such as pediatric critical care and adult critical care. Medical-surgical nurses also are in short supply. Pay for nurses ranges from the low- to mid-$30,000 to start, up to $90,000 for some nurse midwives, to $100,000 or more for nurses in executive management positions.

The shortage has Heisler and other nurses concerned about patient safety.

"Staffing levels have gotten so bad in a lot of hospitals that people are not getting the basic care they deserve. This is all over Florida," said Kathy Hill, 49, a registered nurse since 1979. Hill said patient safety was a major concern of the nurses who last year were successful in getting a union at Holy Cross Hospital in Fort Lauderdale, where she works.

But whether unions can solve the staffing problem remains to be seen.

The U.S. Department of Health and Human Services predicts that nursing vacancies will continue to increase across the country to more than 300,000 this year.

Many experienced nurses have left the profession because of the stress of having to deal with life and death situations every day without enough help, Hill said. The average age of nurses still on the job is 45 because fewer young people are entering the field.

A dire situation

Diane Horner, dean of the University of Miami School of Nursing, said the situation is so dire that 30 South Florida hospitals and others affected by the shortage formed the South Florida Nursing Shortage Consortium. The group has been meeting over the past two years to try to find solutions and to encourage more young people to choose nursing as a career.

The American Association of Colleges of Nursing earlier this month said enrollments in bachelor's degree nursing programs fell nearly 5 percent in the fall of 1999, the fifth-consecutive year of enrollment declines.

"There really is no good short-term fix," Horner said. "Some hospitals are bringing in nurses from overseas but many other countries are having shortages as well."

The shortage is having a ripple effect across the medical community.

Dr. Arthur Palamara, a Broward vascular surgeon who serves on the board of governors of the Florida Medical Association, said doctors across the state find day-to-day patient care in hospitals is affected.

"Without exaggeration, I would say a good 10 percent of the orders I write on the chart are not carried out or not carried out appropriately. There's a lack of efficiency that negatively impacts on patient care," Palamara said.

A 1998 study by the U.S. Agency for Health Care Policy and Research showed surgical patients in hospitals with the fewest registered nurses per patient were more likely to develop urinary tract infections, blood clots, pneumonia and other lung-related problems.

And an Institute of Medicine report issued in December showed that nearly a million patients are injured by medical mistakes every year and as many as 98,000 die.

The American Nurses Association urged a White House task force to examine whether hospital staffing is a key factor in such errors. The association said surveys of nurses identify inappropriate staffing as a factor in drug errors.

Can unions help?

Holy Cross is just one of the South Florida hospitals where nurses want union representation. The North Broward Hospital District, Good Samaritan and St. Mary's medical centers in Palm Beach County also have union activity. Nurses at Jackson Memorial Hospital in Miami have had a union for several years.